2012-12-17_REVISION - M1981088

• Permit No: M1981088
• IBM Index Class Name: REVISION
• Doc Date: 12/17/2012
• Doc Name: SO Appl.
• From: Bratton Enterprises, Inc.
• To: DRMS
• Type & Sequence: SO3
• Email Name: BJC
• Email Name: DMC
• Email Name: GRM
• Media Type: D
• Archive: No

1'
1(. ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No.:
-2-
/
PG' hi 1- lr 1
La .Zt r j VCS
/ l/ / 70` L/)GZri/-) W 66 tf '106
1/1/410 I i-C -
G t/ Zip Code: 0(°-./
L 3 Telephone: &J 7 1 7‘,67'1
Si( ()han r e 817 &Al
6 6 if 1 /
251 Re.M () r) 4 v
Clamp
/ t
L't0 Zip Code: J 0"-5
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5. Application Fee: 5115.00 for Hard Rock operations; $144.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety